APCTC FORMS

These documents recently have been updated.  Translations to other languages will be available soon.  

CONSENT FORM - ENGLISH

CONSENT FORM - KOREAN

CONSENT FORM - SPANISH

CONSENT FORM - TRADITIONAL CHINESE

APCTC WELCOME PACKET - ENGLISH

CONSENT FORM - VIRTUAL ART GALLERY

---

PHI AUTHORIZATION - ENGLISH

PHI AUTHORIZATION - KHMER

PHI AUTHORIZATION - KOREAN

PHI AUTHORIZATION - SIMPLIFIED CHINESE

PHI AUTHORIZATION - SPANISH

PHI AUTHORIZATION - TRADITIONAL CHINESE

PHI AUTHORIZATION - VIETNAMESE

​LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH FORMS

---

notice of privacy practices - english

notice of privacy practices - spanish

Los Angeles County Behavioral Health Services - Member Handbook -multiple languages

patients' rights consumer resource directory - english

REQUEST FOR CHANGE OF PROVIDER FORM - ENGLISH

REQUEST FOR CHANGE OF PROVIDER FORM - SPANISH

beneficiary/client grievance or appeal and authorization forms - multiple languages

---

LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH PROVIDER DIRECTORY

LINK TO DIRECTORY